Preoperative planning and simulation for pedicle screw insertion using computed tomography-based patient specific volume rendering combined with projection fluoroscopy
Preoperative planning and simulation for pedicle screw insertion using computed tomography-based patient specific volume rendering combined with projection fluoroscopy
复制标题
使用基于计算机断层扫描的患者比容渲染结合投影透视进行椎弓根螺钉插入的术前计划和模拟
DOI：
10.15406/iratj.2017.02.00011
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Xiao Zhuang Liu
中科院分区：
文献类型：
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作者：
Ji;A. Han;H. Bai;Yiwen Zhao;Xiao Zhuang Liu
椎弓根螺钉插入已成为稳定脊柱的标准过程[1]。根据切口大小的不同，脊柱手术可分为微创手术和开放手术：微创手术根据术中透视图像植入椎弓根螺钉，以确保进入点和轨迹，开放手术根据解剖标志的识别植入椎弓根螺钉;开放手术需要经验丰富的外科医生。在微创和开放手术中，可以使用术后计算机断层扫描（CT）图像观察螺钉的位置，以评估螺钉放置的准确性，从而改进植入方法[2-4]。椎弓根螺钉插入的过程是复杂的，有一个陡峭的学习曲线。几家机构报告了椎弓根螺钉手术的并发症发生率为3%至55%，错位发生率为1.5%至6.7% [5-13]，破裂发生率为1.5%至58% [12，14，15，16]。然而，由于缺乏来自小型医疗中心和新外科医生的报告，这些结果并不全面。破裂率与外科医生的经验年限有关;对于经验不足5年的外科医生，总体破裂和内侧破裂分别为12.9%和8.0%，对于经验超过5年的外科医生，分别为10.8%和3.5% [17]。这些结果表明，经验丰富的外科医生的内侧破裂率显著较低。
Pedicle screw insertion has been a standard processes for stabilizing the spine [1]. Spinal surgery can be classified as either minimally invasive or open, based on differences in the size of incisions: minimally invasive surgery implants the pedicle screw based on intraoperative fluoroscopic images to ensure the entry point and trajectory, and open surgery implants the pedicle screw based on identification of anatomic landmarks; open surgery needs experienced surgeons. In both minimally invasive and open surgery, the location of the screw can be observed using a postoperative computed tomography (CT) image to evaluate the accuracy of the screw placement to improve the implant method [2-4]. The procedure of pedicle screw insertion is complicated and has a steep learning curve. Several institutions have reported the complication rates for pedicle screw surgery from 3% to 55%, with a rate of malpositioning from 1.5% to 6.7% [5-13] and breach rates from 1.5% to 58% [12,14,15,16]. However, these results were not comprehensive due to a lack of reports from small medical centers and newer surgeons. The breach rates are related with the years of experience of the surgeon; overall breaches and medial breaches are 12.9% and 8.0%, respectively, for surgeons with less than five years of experience, and they are 10.8% and 3.5% [17], respectively, for surgeons with more than five years of experience [17]. These results illustrate that the medial breach rate was significantly lower for the experienced surgeons.